|
HCHG DPLX SCAN-EXTREM VEINS CMPL
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
H9210116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,297.95 |
| Max. Negotiated Rate |
$1,481.19 |
| Rate for Payer: Cash Price |
$992.55
|
| Rate for Payer: Health Management Network Commercial |
$1,297.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,481.19
|
|
|
HCHG DPYD GENE COMMON 3 VARIANT
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
K3000005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$862.33 |
| Rate for Payer: AlohaCare Medicaid |
$174.81
|
| Rate for Payer: AlohaCare Medicare |
$174.81
|
| Rate for Payer: Cash Price |
$577.85
|
| Rate for Payer: Cash Price |
$577.85
|
| Rate for Payer: Devoted Health Medicare |
$192.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$218.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.81
|
| Rate for Payer: Health Management Network Commercial |
$755.65
|
| Rate for Payer: Humana Medicare |
$174.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$560.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$453.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.81
|
| Rate for Payer: MDX Hawaii PPO |
$862.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.81
|
| Rate for Payer: University Health Alliance Commercial |
$647.99
|
|
|
HCHG DPYD GENE COMMON 3 VARIANT
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
K3000005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$755.65 |
| Max. Negotiated Rate |
$862.33 |
| Rate for Payer: Cash Price |
$577.85
|
| Rate for Payer: Health Management Network Commercial |
$755.65
|
| Rate for Payer: MDX Hawaii PPO |
$862.33
|
|
|
HCHG DRAIN ABS/HEMA NASL INT APPRCH
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
H4500861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$279.80
|
| Rate for Payer: AlohaCare Medicare |
$279.80
|
| Rate for Payer: Cash Price |
$863.85
|
| Rate for Payer: Cash Price |
$863.85
|
| Rate for Payer: Cash Price |
$863.85
|
| Rate for Payer: Cash Price |
$863.85
|
| Rate for Payer: Devoted Health Medicare |
$307.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,262.55
|
| Rate for Payer: Health Management Network Commercial |
$1,129.65
|
| Rate for Payer: Humana Medicare |
$279.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$837.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,289.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.80
|
| Rate for Payer: University Health Alliance Commercial |
$968.71
|
|
|
HCHG DRAIN ABS/HEMA NASL INT APPRCH
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
H4500861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,129.65 |
| Max. Negotiated Rate |
$1,289.13 |
| Rate for Payer: Cash Price |
$863.85
|
| Rate for Payer: Health Management Network Commercial |
$1,129.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,289.13
|
|
|
HCHG DRAINAGE OF PILONIDAL CYST
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
H4500919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
|
|
HCHG DRAINAGE OF PILONIDAL CYST
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
H4500919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,412.40
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,262.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$2,618.21
|
|
|
HCHG DRAIN CEREBRO SPINAL FLUID
|
Facility
|
OP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
H4500983
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: AlohaCare Medicaid |
$833.89
|
| Rate for Payer: AlohaCare Medicare |
$833.89
|
| Rate for Payer: Cash Price |
$2,302.95
|
| Rate for Payer: Cash Price |
$2,302.95
|
| Rate for Payer: Cash Price |
$2,302.95
|
| Rate for Payer: Devoted Health Medicare |
$917.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$833.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,365.85
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: Humana Medicare |
$833.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,232.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$833.89
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$917.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$833.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$833.89
|
| Rate for Payer: University Health Alliance Commercial |
$2,582.49
|
|
|
HCHG DRAIN CEREBRO SPINAL FLUID
|
Facility
|
IP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
H4500983
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,011.55 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: Cash Price |
$2,302.95
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
|
|
HCHG DRAIN DENTOALVEOL STRUC LESION
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
H4500414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG DRAIN DENTOALVEOL STRUC LESION
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
H4500414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.18 |
| Max. Negotiated Rate |
$2,833.00 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
|
HCHG DRAIN EXT AUDITORY CANAL ABSC
|
Facility
|
OP
|
$3,406.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
H4500400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,303.82 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Cash Price |
$2,213.90
|
| Rate for Payer: Cash Price |
$2,213.90
|
| Rate for Payer: Cash Price |
$2,213.90
|
| Rate for Payer: Cash Price |
$2,213.90
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,235.70
|
| Rate for Payer: Health Management Network Commercial |
$2,895.10
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,145.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,303.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$2,482.63
|
|
|
HCHG DRAIN EXT AUDITORY CANAL ABSC
|
Facility
|
IP
|
$3,406.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
H4500400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,895.10 |
| Max. Negotiated Rate |
$3,303.82 |
| Rate for Payer: Cash Price |
$2,213.90
|
| Rate for Payer: Health Management Network Commercial |
$2,895.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,303.82
|
|
|
HCHG DRAIN EXT EAR LESION SIMP
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
H4500402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,412.40
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,262.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$2,618.21
|
|
|
HCHG DRAIN EXT EAR LESION SIMP
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
H4500402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
|
|
HCHG DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
H4500989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,076.65 |
| Max. Negotiated Rate |
$6,934.53 |
| Rate for Payer: Cash Price |
$4,646.85
|
| Rate for Payer: Health Management Network Commercial |
$6,076.65
|
| Rate for Payer: MDX Hawaii PPO |
$6,934.53
|
|
|
HCHG DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$7,149.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
H4500989
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,934.53 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$4,646.85
|
| Rate for Payer: Cash Price |
$4,646.85
|
| Rate for Payer: Cash Price |
$4,646.85
|
| Rate for Payer: Cash Price |
$4,646.85
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,791.55
|
| Rate for Payer: Health Management Network Commercial |
$6,076.65
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,503.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,934.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG DRAIN FINGER ABSC COMPL
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
H4500404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,771.43 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,673.05
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,098.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG DRAIN FINGER ABSC COMPL
|
Facility
|
IP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
H4500404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,181.15 |
| Max. Negotiated Rate |
$4,771.43 |
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
|
|
HCHG DRAIN FINGER ABSC SIMP
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
K3610000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG DRAIN FINGER ABSC SIMP
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
H4500406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$237.02
|
| Rate for Payer: AlohaCare Medicare |
$237.02
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$260.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,171.35
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.02
|
| Rate for Payer: University Health Alliance Commercial |
$898.73
|
|
|
HCHG DRAIN FINGER ABSC SIMP
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
H4500406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG DRAIN FINGER ABSC SIMP
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
K3610000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.86 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$237.02
|
| Rate for Payer: AlohaCare Medicare |
$237.02
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$260.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$296.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.02
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.02
|
| Rate for Payer: University Health Alliance Commercial |
$898.73
|
|
|
HCHG DRAIN MOUTH LESION SIMP
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
H4500410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$836.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,412.40
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,262.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$2,618.21
|
|
|
HCHG DRAIN MOUTH LESION SIMP
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 40800
|
| Hospital Charge Code |
H4500410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
|
